Analysis Of Post Ureteroscopic Lithotripsy Ureteral Strictures Management

Purpose: To investigate the diagnosis,treatment and prognosis of ureteral stricture related to Ureteroscopic Lithotripsy(URSL),and furtherly to provide reference for the future diagnosis and treatment of such ureteral stricture.Materials and Methods: We retrospectively reviewed the records of95 patients managed at our hospital between January 2013 and January2018 with the diagnosis of ureteral strictures after URSL.All patients got appropriate treatments,we collected the preoperative,intraoperative and postoperative information to systematically analyze the stenosis characteristics and outcome of different treating methods.Furtherly,we reviewed the relevant literature to summarize the risk factors of postoperative stenosis.Result: All except two Nephrectomy patients were followed at least13 months,the follow-up time ranged from 13 to 57 months,with a median time of 24.The results showed that the success rate of endourological group was significantly lower than that in the reconstruction group:60.9%(42/69)vs 97.3%(36/37),p <0.001.while 74.4%(29/39)patients with stricture less than 1 cm and 68.8%(33/48)patients with mild-to-moderate hydronephrosis achieved success in endourological group.Twenty-two of the 23 patients experienced stenosis recurrences within the first year postoperatively,one failure in endourological group occurred in 18 months postoperatively,with a median recurrence time of 7 months.Subgroupanalyses for endourological procedures revealed significant differences in the success rate of different stricture lengths and hydronephrosis(p = 0.004 and p = 0.043).Multivariate Cox regression analysis indicated that surgical type was the only predicting factor for stenosis recurrence,and reconstruction was significantly related to a more successful outcome,compared with endourological procedures(HR 0.052,95% CI 0.007–0.394,p = 0.004).Conclusion: As a distant complication of URSL,ureteral strictures can be severe,we should try our best to minimizing such incident.If it occurs,timely diagnosis and appropriate treatment would be of crucial importance.For treating procedures,reconstruction procedure provides a more reliable success outcome.Considering the unique advantages of minimal invasion and coverage,the success rate of endoscopic management was also acceptable for selective patients with shorter stenosis and slight hydronephrosis.And most stenosis recurrence occurred within the first year postoperatively,which may indicate a necessity for closer follow-up during 12 months postoperatively.